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Anganwaadi Facility Template -Form Fill
INFORMATION
Q01
Name of the village
Q02
Name of the Panchayat
Q03
Angawaadi Code
Q04
AWW’s Name
Q05
Interview Details
Q05_1
Date
Q05_2
Interviewer's Name
Q05_3
Interviewer’s code
Q05_4
Result
Completed
Not at home
Postponed
Refused
Partly Completed
No Eligible Person
Eligible Person Incapacitated
Others (specify)
GENERAL INFORMATION
A01
When did this Anganwaadi start operations
A02
Since when did you join as the Anganwaadi Worker
A03
Do you stay in the same village?
Yes
No
A03A
If No, how far from the village do you stay?
A04
During the last 12 months, has it ever happened that the Anganwaadi has remained closed?
Yes
No
A05
During the last month (March), for how many days was the Anganwaadi functioning?
A06
On an average for how many hours does the Anganwaadi function in a day?
A07
What are the main services provided by you?
Pre Schooling
Nutrition Support
Immunization
Referral Services
Registration of Births and Deaths
Others
A08
How Many registers do you maintain
A09
Enrollment Details
A09A
What is the average attendance every day
A09A_1
Children 0-3 years
A09A_2
Children 3-6 years
A09A_3
Pregnant women
A09A_4
Lactating women
A09A_5
Adolescent Girls
A10
When was the last visit made by
A10_1
ANM
A10_2
FLW
A10_3
CDPO
A10_4
DPO
A10_5
Sarpanch
Facilities Available
B01
Where is the Anganwaadi Housed?
Own Building
Rented Building
Anganwaadi Worker’s Home
Anganwaadi Helper’s Home
Panchayat Bhawan
Village School
Others
B02
What is the area of the Anganwaadi?
B03
How many rooms does the Anganwaadi have?
B04
What is condition of the Anganwaadi?
B04_1
Anganwaadi building needs repair
Yes
No
B04_2
Anganwaadi is well ventilated
Yes
No
B04_3
Anganwaadi is well lit
Yes
No
B05
Are the following facilities available at the Anganwaadi?
B05_1
Electricity Connection
Yes
No
B05_2
Electricity Fan in the Rooms
Yes
No
B05_3
Clean drinking water
Yes
No
B05_4
Toilet
Yes
No
B05_5
Indoor Activity Space
Yes
No
B05_6
Examination Area
Yes
No
B05_7
Separate Kitchen/Cooking space
Yes
No
B05_8
Storage Facility
Yes
No
B06
Does the Anganwaadi have the following items?
B06_1
Medicine Kit/First Aid Box
Yes, in good condition
Yes, but not in good condition
Not Available
Could Not Observe
B06_2
Baby Weighing scale
Yes, in good condition
Yes, but not in good condition
Not Available
Could Not Observe
B06_3
Wall Charts & Paintings
Yes, in good condition
Yes, but not in good condition
Not Available
Could Not Observe
B06_4
Vessels for cooking
Yes, in good condition
Yes, but not in good condition
Not Available
Could Not Observe
B06_5
Teaching Learning Material
Yes, in good condition
Yes, but not in good condition
Not Available
Could Not Observe
B06_6
Indoor Play Items
Yes, in good condition
Yes, but not in good condition
Not Available
Could Not Observe
B06_7
Vessel for storing water
Yes, in good condition
Yes, but not in good condition
Not Available
Could Not Observe
B07
When is the last time the following services were provided to children at the AWC?
B07_1
Supplementary Nutrition
Today or yesterday
Within the last 7 days
Within the last 15 days
Within the last 30 days
Within the last 12 months
Not even within the last 12 months
Unclear
B07_2
Pre-schools Education
Today or yesterday
Within the last 7 days
Within the last 15 days
Within the last 30 days
Within the last 12 months
Not even within the last 12 months
Unclear
B07_3
Weighing of Children
Today or yesterday
Within the last 7 days
Within the last 15 days
Within the last 30 days
Within the last 12 months
Not even within the last 12 months
Unclear
B07_4
Immunization
Today or yesterday
Within the last 7 days
Within the last 15 days
Within the last 30 days
Within the last 12 months
Not even within the last 12 months
Unclear
B07_5
Health Check up
Today or yesterday
Within the last 7 days
Within the last 15 days
Within the last 30 days
Within the last 12 months
Not even within the last 12 months
Unclear
B07_6
Referral
Today or yesterday
Within the last 7 days
Within the last 15 days
Within the last 30 days
Within the last 12 months
Not even within the last 12 months
Unclear
B07_7
Deworming
Today or yesterday
Within the last 7 days
Within the last 15 days
Within the last 30 days
Within the last 12 months
Not even within the last 12 months
Unclear
B08
In your Opinion, has there been a change in the following over the last 2 years?
B08_1
Infrastructure
Improvement
No difference
Worsening
Can't say
B08_2
Training of AWW
Improvement
No difference
Worsening
Can't say
B08_3
Inspection and Monitoring
Improvement
No difference
Worsening
Can't say
B08_4
Salaries
Improvement
No difference
Worsening
Can't say
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